Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Diabetes Sci Technol. 2021 May;15(3):630-635. doi: 10.1177/1932296820906214. Epub 2020 Mar 14.
We determined the uptake rate of continuous glucose monitors (CGMs) and examined associations of clinical and demographic characteristics with CGM use among patients with type 1 diabetes covered by Colorado Medicaid during the first two years of CGM coverage with no out-of-pocket cost.
We retrospectively reviewed data from 892 patients with type 1 diabetes insured by Colorado Medicaid (Colorado Health Program [CHP] and CHP+, Colorado Medicaid expansion). Demographics, insulin pump usage, CGM usage, and hemoglobin A1c (A1c) were extracted from the medical record. Data downloaded into CGM software at clinic appointments were reviewed to determine 30-day use prior to appointments. Subjects with some exposure to CGM were compared to subjects never exposed to CGM, and we examined the effect of CGM use on glycemic control.
Twenty percent of subjects had some exposure to CGM with a median of 22 [interquartile range 8, 29] days wear. Sixty one percent of CGM users had >85% sensor wear. Subjects using CGM were more likely to be younger ( < .001), have shorter diabetes duration ( < .001), and be non-Hispanic White ( < .001) than nonusers. After adjusting for age and diabetes duration, combined pump and CGM users had a lower A1c than those using neither technology ( = .006). Lower A1c was associated with greater CGM use ( = .002) and increased percent time in range ( < .001).
Pediatric Medicaid patients successfully utilized CGM. Expansion of Medicaid coverage for CGM may help improve glycemic control and lessen disparities in clinical outcomes within this population.
我们确定了连续血糖监测仪（CGM）的使用率，并研究了在科罗拉多医疗补助计划（Colorado Medicaid）覆盖的 1 型糖尿病患者在头两年内接受 CGM 治疗且无需自费的情况下，临床和人口统计学特征与 CGM 使用之间的关联。
我们回顾性地审查了 892 名接受科罗拉多医疗补助计划（Colorado Health Program [CHP] 和 CHP+，科罗拉多医疗补助扩大计划）承保的 1 型糖尿病患者的医疗记录中的数据。从病历中提取人口统计学、胰岛素泵使用情况、CGM 使用情况和糖化血红蛋白（A1c）数据。在诊所预约时将数据下载到 CGM 软件中，以确定预约前 30 天的使用情况。将有 CGM 接触史的受试者与从未接触过 CGM 的受试者进行比较，并检查 CGM 使用对血糖控制的影响。
20%的受试者有过 CGM 接触史，中位数为 22 天（四分位距 8，29 天）。61%的 CGM 用户的传感器使用率>85%。与非使用者相比，使用 CGM 的受试者更年轻（<0.001）、糖尿病病程更短（<0.001）、非西班牙裔白人（<0.001）的可能性更高。在调整年龄和糖尿病病程后，同时使用胰岛素泵和 CGM 的患者的 A1c 低于既不使用这两种技术的患者（=0.006）。更高的 A1c 与更高的 CGM 使用（=0.002）和增加的时间在目标范围内的百分比（<0.001）相关。
儿科 Medicaid 患者成功使用了 CGM。扩大 Medicaid 对 CGM 的覆盖范围可能有助于改善这一人群的血糖控制，并减少临床结果的差异。
